Fatal group A streptococcal infection with toxic shock syndrome: complicating minor orthopedic trauma.

Since 1987, reports have appeared of a streptococcal toxic shock syndrome in various clinical settings. None have appeared in the orthopaedic literature. Between 1989 and 1991 at our institution three patients with relatively minor orthopaedic injuries or procedures died of group A streptococcal infections complicated by toxic shock syndrome. The manifestations of this syndrome included rapid progression of systemic sepsis, necrotizing soft-tissue infections, acute renal failure, adult respiratory distress syndrome, and coagulopathy. All three patients died despite aggressive resuscitative measures and surgical debridement. Optimal treatment of this life-threatening process requires early recognition, aggressive surgical debridement, appropriate antibiotic management, and intensive care unit support.